This document discusses fungal infections caused by Candida species, specifically Candida albicans. It classifies fungal diseases as cutaneous or opportunistic and describes candidiasis, the most common fungal infection. Candidiasis can present in various forms depending on the site, from oral thrush to diaper rash. Predisposing factors include moisture, medication use, and weakened immunity. Oral candidiasis is further described, outlining types like denture stomatitis and angular cheilitis. Diagnosis involves smears, cultures, and biopsy. Treatment focuses on managing predisposing factors and using antifungal medications like nystatin or azoles.

1. Fungal infections
By
Shatha abdelmawla alsulh

2. Classifications:
•Cutaneous fungal diseases:
•Superficial:
• Noninflammatory
• Inflammatory
•Deep:
• inoculation
• Hematogenous spread
•Opportunistic pathogens

3. Candidiasis

4. •Most commonly due to Candida albicans or C. tropicalis
•Predisposing factors
• Local factors :
• Warmth and moisture
• superinfection
• Higher skin pH
• General factors :
• Drugs
• diseases
• young children: neither fully developed immune system nor
oral microflora

5. Wide spectrum of clinical presentations :
• Mucosal candidiasis:
• Oral candidiasis
• Candidal vulvovaginitis
• Cutaneous:
• Candidal intertrigo
• Diaper candidiasis
• Congenital cutaneous candidiasis
• Perianal candidiasis
• Candidal paronychia
• Erosio interdigitalis blastomycetica
• Chronic mucocutaneous candidiasis
• Systemic candidiasis

6. ORAL CANDIDIASIS

7. • the most prevalent opportunistic infection affecting
the oral mucosa
• affect mucosal linings (Most).
• systemic manifestations may have a fatal course
(rare).
• divided into
• primary infections: restricted to the oral and perioral sites
• secondary infections: accompanied by systemic
mucocutaneous manifestations

8. Etiology and Pathogenesis:
• C. albicans, C. tropicalis, and C. glabrata
• Virulence factors:
• adhere to the epithelial surface
• yeasts’ penetration facilitated by lipases
• overcome constant desquamation
• predisposing factors:
• Local:
• promote growth of the yeast
• affect the immune response of the oral mucosa
• General
• Candida-associated infections:
• Denture stomatitis
• angular cheilitis
• median rhomboid glossitis

10. Epidemiology
• large geographic variations
• Candidal strains are more frequently isolated from
women
• seasonal variation (summer)
• Hospitalized patients (higher prevalence)
• complete denture-wearers: from 11%–67%.

11. Clinical Findings:
• Pseudomembranous Candidiasis (thrush)
• Erythematous Candidiasis
• Chronic Plaque-Type and Nodular Candidiasis
• Denture Stomatitis
• Angular Cheilitis (Perlèche)
• Median Rhomboid Glossitis
• Oral Candidiasis Associated with HIV
• Secondary oral candidiasis

12. Pseudomembranous Candidiasis (thrush):
• classic candidal infection
• Symptoms: infrequent, some discomfort
• presents with loosely attached
membranes, leaves an inflamed or
bleeding area if removed
• DD: food debris (egg , yoghurt)
• chronic form:
• HIV infection
• steroid inhalers

14. Erythematous Candidiasis
(atrophic oral candidiasis):
• atrophy & increased vascularization
• successor to pseudomembranous
candidiasis or emerge de novo.
• DD: erythroplakia
• Sites:
• palate
• dorsum of the tongue

15. Chronic Plaque-Type and
Nodular Candidiasis:
•older term: candidal
leukoplakia
•c/p: white irremovable
plaque
•DD: oral leukoplakia
•associated with malignant
transformation

16. Denture Stomatitis:
• denture- bearing palatal mucosa
• Denture is vehicle that
accumulates sloughed epithelial
cells and protects the
microorganisms from physical
influences
• May contain bacteria (as
Streptococcus)

17. Angular Cheilitis (Perlèche) :
• infected fissures of the commissures of the
mouth
• often surrounded by erythema
• coinfected with Staphylococcus aureus
• DD:
• VitaminB12 deficiency
• iron deficiencies
• loss of vertical dimension
• Predisposing factors
• Atopy
• 30% of denture stomatitis pt

18. Median Rhomboid Glossitis:
• asymptomatic
• oval erythematous lesion
• center of the posterior part of the dorsum of the tongue
• atrophy of the filiform papillae and lobulated surface
• kissing lesions on palatal mucosa
• shows a mixed bacterial/fungal microflora.
• Biopsies :candidal hyphae in 85%
• management :reduction of predisposing factors
• No increased risk for malignant transformation

19. Oral Candidiasis Associated with HIV:
• > 90% have had oral candidiasis during the course
• is considered a portent of AIDS development
• types of oral candidiasis
• pseudomembranous candidiasis
• Erythematous candidiasis
• angular cheilitis
• chronic plaque-like candidiasis
• the prevalence has decreased due to HAART

20. Secondary oral candidiasis :
•accompanied by systemic mucocutaneous candidiasis and
other immune deficiencies
•Chronic mucocutaneous candidiasis (CMC)
• heterogeneous group of disorders
• charecterised by
• oral candidiasis: plaque-like and fissures
• affection of the skin and other mucosal linings (genital)
• face and scalp : granulomatous masses
• Can occur as part of endocrine disorders
• Impaired phagocytic function by neutrophilic granulocytes and
macrophages

22. Diagnosis and Laboratory Findings:
• Smear
• Culture
• Imprint culture technique
• Salivary culture techniques
• histopathologic examination

23. Management:
•predisposing factors
•antifungal regimens
• Polyenes
• nystatin and amphotericin B
• Not absorbed from GIT
• not associated with development
of resistance
• negative effect on the production
of ergosterol
• affect the adherence of the fungi
•Azoles
• Topical: miconazole
• Systemic:
• For:
• deeply seated primary candidiasis
• therapy-resistant infection
• treatment of secondary oral
candidiasis
• systemic candidiasis
• disadvantages
• interact with warfarin
• Development of resistance